Healthcare Provider Details

I. General information

NPI: 1861363301
Provider Name (Legal Business Name): LARRY BLAKE MARSHALL PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

IV. Provider business mailing address

1471 JOHNS BR
LANGLEY KY
41645-9056
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025327
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: